Chronic Pain Epidemic
In the months before her wedding, Ashlee Williams should have been focusing on the big day. Instead, the 28-year-old kindergarten teacher from Atlanta was often curled up in bed with pain caused by endometriosis, a disease that creates growths and lesions in the pelvic cavity and abdomen. Over the last 14 years, Ashlee has tried numerous treatments, including surgery, but the lesions always return. "I can barely remember a time when I wasn't in pain," she says. "It's been hell."
Ashlee is one of the 50 million Americans who suffer from the never-ending agony of chronic pain. Once thought to be a side effect of other illnesses, chronic pain is now considered a serious health condition, one that costs the country an estimated $100 billion in lost workdays and medical care. Today, there are almost 1,900 board-certified pain practitioners in the United States — more than ever before.
In addition, chronic pain affects women more than men. According to the American Chronic Pain Association, 61 percent of all chronic pain sufferers are female. Yet many doctors still don't take women's complaints about pain seriously. "Some physicians have the impression that because women go through childbirth they can tolerate more," says Roger B. Fillingim, PhD, an associate professor of community dentistry and behavioral sciences at the University of Florida College of Dentistry. "Others assume that women are exaggerating their discomfort — that it's all in their heads."
But new research shows that living with constant pain can have serious health consequences: Every year that a person suffers can cause the brain to shrink; after about 10 years, it can shrink by as much as 11 percent, potentially diminishing memory and the ability to process information. According to studies at Northwestern University, these changes can be permanent. Worse still, such changes in the brain may make the pain less responsive to treatment. "Getting help quickly is imperative," says A. Vania Apkarian, PhD, an associate professor of physiology at Northwestern University.
Women, Hormones, and Pain
Experts aren't sure why women experience more chronic pain than men, but they suspect we may be built to feel it more acutely. "Women report more episodes of severe pain, as well as pain in more parts of the body, than men do," says Fillingim.
The physiology of chronic pain is a mystery. Normally, when the body is injured, the nervous system sends pain signals to the brain until the ailment heals. But with chronic pain, the process malfunctions, and the signals — and the hurt — continue.
For women, the likely culprits are female hormones like estrogen and progesterone, which regulate everything from sex drive to periods to pregnancy. Studies suggest that when estrogen levels are high — typically right after a woman has her period or during pregnancy — the brain releases natural painkillers, such as endorphins, that provide relief. When estrogen levels fall, the soothing effect disappears. "Women with a chronic condition, such as migraines, almost always report that pain gets worse premenstrually or during a period," says Allen Lebovits, PhD, an associate professor of anesthesiology and psychiatry at New York University Medical Center.
Hormones are just part of the picture, however. Intriguing new research showing that men and women respond differently to pain medication suggests that women's brains may be wired to process agony in a unique way. "The systems that transmit and control discomfort may be fundamentally different," says Fillingim. Scientists believe there may be an evolutionary reason for this: In prehistoric times, men couldn't afford to be sidetracked by pain because they had to hunt and kill their family's dinner. Women, on the other hand, had to be highly receptive to others' distress — a baby crying, for example — in order to ensure the survival of the species. Over time, the theory goes, this trait may have evolved into a sensitivity to pain.
The Problem with Pain Diagnosis
While the caveman and woman scenario is still speculation, what doctors do know for sure is that biology plays a role. For one thing, certain conditions have very different symptoms in the two genders. A woman having a heart attack typically experiences more back and jaw pain, as well as more fatigue, indigestion, and nausea than a man. And women are afflicted with many more excruciating conditions, such as arthritis and lupus, than men are, although no one knows why.
Finally, a number of ailments specific to women are notoriously difficult to diagnose. According to the Endometriosis Association, it takes women about nine years to get the condition labeled correctly. Many spend more years seeking relief.
Just ask Jennifer Singer, 39, a writer in Kinnelon, New Jersey, who changed her diet, tried hormone treatments and even finally had five surgeries for endometriosis but still experiences daily pain. "When I was giving birth to my son, I expected to have the worst agony of my life," she says. "But labor was no worse than the pain I felt every month when I got my period."
Finding Pain Relief
Fortunately for sufferers, relief may be in sight. As awareness of chronic pain as a health threat grows, and as the demand for help skyrockets, medical schools are teaching courses in pain management. So your chances of getting the right treatment are better than ever. Here's how — and where — to find help.
See a pain specialist. Ask your doctor for a referral to a pain practitioner, a physician who is trained and certified by a group such as the American Board of Pain Medicine. Or find an expert yourself. Choose one who's a member of the American Academy of Pain Medicine; go tofor a list by region. Describe your pain to the doctor — where it is, when it started, what it feels like, and the intensity on a scale of 1 to 10. The more precise you can be, the better.
Go to a pain clinic. "These centers are often the most effective way to get evaluated properly because they offer a range of treatments for every kind of pain all under one roof," says Lebovits. Pain clinics typically take a mind-body approach and tackle pain with several different treatments including medication, physical therapy, counseling, and alternative therapies such as acupuncture, biofeedback, and guided imagery.
Finding a doctor who took her pain seriously is what finally gave Ashlee Williams relief from her endometriosis. Her new gynecologist prescribed Lupron, a medication that suppresses the production of estrogen, which spurs the growth of painful endometrial tissue. "It's a miracle drug," says Ashlee. "It helps 100 percent. Now I can enjoy my life again, pain-free."
Pain Relief Treatment Options
Here, the most exciting advances in both traditional and alternative remedies.
Potent painkillers such as the opioids vicodin and oxycontin
- Helps: Everything from lower-back pain to cancer pain. These are often prescribed by doctors when over-the-counter anti-inflammatories, such as aspirin, don't work. (A recent study of patients with spinal diseases concluded that use of opioids rarely led to addiction.)
Antidepressants such as Elavil, and antiseizure medications such as neurontin
- Helps: Fibromyalgia and interstitial cystitis, a painful bladder disorder. These drugs work by easing neurological discomfort, including burning sensations and stabbing pains.
Interventional pain management
- Helps: Cancer pain, and lower-back, neck, and shoulder pain. In this procedure, doctors inject local anesthetics directly into the nerves responsible for pain, preventing signals from reaching the brain.
Spinal cord stimulation
- Helps: Back pain, leg pain. Doctors use an implanted device to deliver a mild electrical current that competes with pain signals.
- Helps: Lower-back pain, chronic headaches, arthritis and cancer pain. Acupuncture signals the brain to release soothing chemicals such as serotonin and endorphins. Chronic headache sufferers who received acupuncture had a 34 percent reduction in pain compared with a 16 percent drop among those who got standard care, according to a 2004 study from Memorial Sloan-Kettering Cancer Center in New York City.
- Helps: Chronic headaches. A combination of electrical stimulation and acupuncture, this technique works in the same way acupuncture does. In a study done in Australia, researchers discovered that patients who received electroacupuncture reported fewer tension-type headaches than those in the control group.
Percutaneous electrical nerve stimulation (PENS)
- Helps: Neurological pain caused by diabetes. PENS is similar to electroacupuncture, but in this procedure, the practitioner places the needles in a different pattern. In a study at the University of Texas Southwestern Medical Center, patients who were treated with PENS were able to cut their use of pain medication by almost half.
- Helps: Fibromyalgia, tension headaches, and cancer pain. Patients use visualization to control their pain. For instance, those with back pain might see their discomfort as a boulder weighing down on them. They would then imagine it turning into a feather and floating away.
- Helps: A wide variety of conditions, including migraines, arthritis, and fibromyalgia. By using special devices designed to pick up electrical signals in the muscles and to flash or beep when they tighten, pain sufferers learn to reduce muscle tension, one of the things that fuels their discomfort.
- Helps: Lower-back pain and carpal tunnel syndrome. The stretching and held poses in yoga may release feel-good chemicals that reduce stress.
- Helps: Lower-back pain. This hands-on therapy often helps relieve the muscle tension causing chronic pain and releases neurochemicals that make patients feel better. A study at the University of Miami School of Medicine found that massage not only significantly reduced back pain but also eased depression and anxiety and boosted flexibility.